Horvath Lena, Seeber Andreas, Uprimny Christian, Wolf Dominik, Nachbaur David, Kocher Florian
Department of Internal Medicine V (Hematology and Oncology), Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Tirol, Austria.
Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Tyrol, Austria.
Ther Adv Hematol. 2020 Dec 21;11:2040620720977613. doi: 10.1177/2040620720977613. eCollection 2020.
Combined F-fluoro-deoxyglucose ([18F]FDG) positron emission tomography and computed tomography ([18F]FDG-PET/CT) is increasingly used for the diagnostic and therapeutic management of hematologic and non-hematologic malignancies. Here, we describe a unique case of a patient presenting with very severe aplastic anemia and a mediastinal mass showing disseminated hypermetabolic lesions of the bones after receiving granulocyte colony-stimulating factor (G-CSF), highly suspicious for disseminated metastatic lesions. A 71-year-old patient presented with a 3 week history of dyspnea and fatigue. Blood tests showed severe pancytopenia and iliac crest bone marrow biopsy revealed an extensively hypoplastic bone marrow. Diagnostic work-up by histology, conventional cytogenetics and flow cytometry confirmed the diagnosis of very severe aplastic anemia. Besides blood transfusions, the patient was treated with G-CSF. Furthermore, computed tomography revealed a suspect mass in the anterior mediastinum, presenting with moderate glucose metabolism in the subsequent [18F]FDG-PET/CT scan. In addition, multiple disseminated and highly metabolic bone lesions of primarily the ribs were detected, suspicious of malignant bone infiltration. Since physiologic bone marrow activation by G-CSF-stimulation could not be ruled out, G-CSF therapy was interrupted to repeat the PET/CT scan 10 days later. On the second [18F]FDG-PET/CT the moderately hypermetabolic mediastinal mass persisted. However, the initially FDG-avid bone lesions almost completely resolved, rendering the diagnosis of G-CSF-induced bone marrow hypermetabolism very likely without the need for further invasive diagnostic procedures. The mediastinal mass was thereafter histologically verified as thymoma. Interpretation of [18F]FDG-PET/CT in patients with aplastic anemia may be complicated by the frequent therapeutic use of G-CSF. With G-CSF, islets of residual bone marrow activity can be visualized on [18F]FDG-PET/CT images that might be misinterpreted as malignant bone infiltration. Repeating PET/CT scan after G-CSF discontinuation can prevent unnecessary invasive diagnostic procedures in these patients.
氟代脱氧葡萄糖（[18F]FDG）正电子发射断层扫描与计算机断层扫描相结合（[18F]FDG-PET/CT）越来越多地用于血液系统和非血液系统恶性肿瘤的诊断和治疗管理。在此，我们描述了一例独特病例，一名患有非常严重再生障碍性贫血的患者，其纵隔肿块在接受粒细胞集落刺激因子（G-CSF）后出现骨骼弥漫性高代谢病变，高度怀疑为弥漫性转移性病变。一名71岁患者出现了3周的呼吸困难和疲劳病史。血液检查显示严重全血细胞减少，髂嵴骨髓活检显示骨髓广泛发育不全。通过组织学、传统细胞遗传学和流式细胞术进行的诊断检查证实了非常严重再生障碍性贫血的诊断。除了输血外，该患者接受了G-CSF治疗。此外，计算机断层扫描显示前纵隔有一个可疑肿块，在随后的[18F]FDG-PET/CT扫描中表现为中度葡萄糖代谢。此外，主要在肋骨发现了多个弥漫性高代谢骨病变，怀疑为恶性骨浸润。由于不能排除G-CSF刺激引起的生理性骨髓激活，G-CSF治疗中断，10天后重复进行PET/CT扫描。在第二次[18F]FDG-PET/CT上，中度高代谢的纵隔肿块持续存在。然而，最初的FDG摄取阳性的骨病变几乎完全消退，使得很可能诊断为G-CSF诱导的骨髓高代谢，无需进一步的侵入性诊断程序。此后，纵隔肿块经组织学证实为胸腺瘤。再生障碍性贫血患者的[18F]FDG-PET/CT解读可能因G-CSF的频繁治疗使用而变得复杂。使用G-CSF时，残留骨髓活性的岛状区域可在[18F]FDG-PET/CT图像上显示，可能被误诊为恶性骨浸润。在停用G-CSF后重复进行PET/CT扫描可避免这些患者进行不必要的侵入性诊断程序。
